Analysis of Various Histopathological Patterns in Pleomorphic Adenoma - An Institutional Case Study

Introduction: Pleomorphic adenoma, the most common benign mixed salivary gland tumor which accounts for 70-80%, is a biphasic tumor with dual origin from epithelial and myoepithelial elements. It shows a malignant transformation rate of 6%. Microscopically, pleomorphic adenoma characteristically displays vast morphologic diversity. This present study is done to analyze prevalence rates and histomorphological variations to better elucidate the pattern of occurrence, diagnosis and treat- ment plan of pleomorphic adenoma. Materials and Methods: This are a retrospective study which was conducted in a private institution, Chennai. Based on the proportion of parenchymal and stromal tumor components, the cases were classified into four subtypes as proposed by Foote and Frazell. Morphological patterns, cellular patterns, capsular alterations and Stromal components were analyzed and statisti- cally evaluated. Results: Our analysis showed an overall 0.87% of pleomorphic adenoma cases being reported were associated with minor salivary glands followed buccal mucosa and palate. All the reported cases showed Type II pattern with histological cellular pat- tern of spindle cells and ductal morphological pattern. Conclusion: We observed the great diversity of morphological aspects of the stroma in pleomorphic adenoma, in which many cases showed variation in morphology and cellularity associated with tumor location.

Case Analysis and Systematic Review of Aspergilloma

Introduction: Aspergillus fumigatus is the most prevalent fungal pathogen reported to cause diseases such as aspergilloma or aspergillosis in humans. Aspergillomas are commonly seen in a poorly drained and avascular cavitary space. Paranasal sinuses are most commonly involved, especially maxillary sinus. In the past two decades, the incidence of aspergillosis has increased substantially. Aims: To evaluate cases reported as aspergilloma of the maxillary sinus and to determine the percentage of cases involving aspergilloma of the maxillary sinus in healthy individuals. Materials and Methods: After the final full-text review,16 articles were included in this systematic review. Data extracted from these full-text articles was reviewed. Results: 83 % of cases had a history of dental procedures, with 42 % of those being due to infection from previous extraction sockets and 41 % due to root canal therapy (RCT). About 43% of the patients were immunocompromised, while 56% were healthy without any predisposing conditions. Conclusion: Aspergillus fungal infections of the paranasal sinuses are common and can occur in apparently healthy as well as immunocompromised individuals. Aspergilloma is the most common fungal infection involving the maxillary sinus with iatrogenic-dentogenic factors being predominant for initiation and progression of the infection. About 43% of the patients in this review were immunocompromised patients whereas 56% of the patients were healthy without any known predisposing condi- tions. The progression and prognosis of this disease depends on the location and immunologic status of the patient. So, it is very important for dentists to be cautious while performing any dental procedures so as not to initiate any iatrogenic infections.

Knowledge and Awareness about Chair-Side Diagnostic Techniques for the Screening of Suspicious Oral Lesions among General Dental Practitioners - A Cross-Sectional Survey

Introduction: General dental practitioners (GDPs) play an important role in screening and early detection of oral potentially malignant disorders (OPMD) and oral cancer. Aim: This survey aims to assess the knowledge and awareness of general dental practitioners about chairside diagnostic techniques for screening of inflammatory oral lesions, potentially malignant lesions and oral cancer. Materials and Methods: GDPs (n=125) were surveyed about their knowledge about chairside diagnostic techniques for early detection and screening of suspicious oral lesions. The interview was based on a pre-structured questionnaire containing 14 closed ended questions. Chi square test was used for evaluating the association of survey parameters. Result: 95.2% of dentists do diagnosis and management of suspicious oral lesions along with chief complaints. There is a strong association between the educational status of GDPs and their method for management of suspicious oral lesions (p=0.002). 84.5% of the postgraduate GDPs are aware of chemiluminescence methods than graduate level GDPs (p =0.0009). Majority of the graduate GDPs are unaware of VELScope(p=0.0009). Usage of all non-invasive techniques was found to be less among graduate GDPs (p=0.002). Conclusion: The overall awareness of the dentists involved in the study were good and postgraduate GDPs are more aware and practically ahead about the non-invasive diagnostic techniques than graduate GDPs.

Effect of ethanolic extract of Centella asiatica on maximal electroshock seizure in albino mice

Background: Animal models had always served as integral part in introducing newer drugs for epilepsy. India has long tradition of using herbal medicines. Centella asiatica is an ingredient of various ayurvedic preparations to treat brain related disorders like insanity, memory loss and epilepsy. This research is done to find out the usefulness of Centella asiatica in epilepsy.  Methods: Ethanolic extract of the plant is prepared using Soxhlet apparatus. Experimental seizure is induced in albino mice by maximal electroshock method. Resulting seizure goes through different phases. Duration of the phase of hind limb extension was the measured data. Clinically used anti epileptic drugs can abolish hind limb extension. Effect is compared to that of standard drug phenytoin. Four different doses of the plant extract; 100mg, 200mg, 500mg and 1000mg per kilogram bodyweight was given orally. Statistical analysis of data was done by one way ANOVA and Dunnett test.Results: Ethanolic extract of Centella asiatica exhibited statistically significant protection from maximal electroshock seizures. All given doses of the extract had p<0.05 when compared to control.Conclusions: Centella asiatica is potential source of anti-epileptic drug. Detailed phytochemical studies and animal experiments are recommended.

Prevalence of multiple myeloma and its complication in a tertiary medical college at Calicut district, India

Background: Multiple myeloma is a blood cancer that develops in the bone marrow, which is soft, spongy tissue found in the center of many bones where blood cells are produced. In myeloma, plasma cells, which are normal antibody-producing cells, transform into cancerous myeloma cells. The objectives of this study was the prevalence and complications of multiple myeloma.Methods: A cross sectional study was conducted in a tertiary hospital at Calicut. Semi structured questionnaire was used to study the prevalence and associated complications of multiple myeloma. History taking, physical examinations and investigations like hemoglobin estimation, peripheral smear, electrophoresis, renal function test, calcium estimation, X-ray of thoracic, lumbar spine, humerus, hip region was done. There was also an attempt to find co-morbidities hypertension, diabetes mellitus and neurological abnormalities. The variables was entered into excel and data were expressed in tables. Results: The prevalence of multiple myeloma in Calicut was found to be 77.90% of the bone marrow results were consistent with multiple myeloma. Urine Bence jone protein was positive for 22.9% of cases. Electrophoresis was done and M Band was seen positive for 78.6%. Serum blood urea value was more for 25.7% patients and 22.95% had elevated serum creatinine value. Spine compression was found among 41.4% and osteoporosis was seen in 21.4% patients. Hypertension was seen among 90% cases and Diabetes Mellitus in 4.7% of males.10 % of the patient has valvular heart disease.Conclusion: The study was able to find out the prevalence and project complications of multiple myeloma at Calicut. As there are cases in the district, present medicos who are the future doctors should be trained appropriately to diagnose and treat the disease.

Stromal myofibroblasts in oral squamous cell carcinoma and potentially malignant disorders.

INTRODUCTION: Concurrent with the progression of a non- diseased epithelium to the pre-cancerous epithelium to carcinoma, the stroma also undergoes modifications. Myofibroblasts are important stromal cells that play a crucial role in carcinogenesis. The current study investigated the presence of myofibroblasts in healthy oral mucosa, potentially malignant disorders (PMDs) and squamous cell carcinoma (SCC). MATERIALS AND METHODS: The study material consisted of a total of 106 samples categorized into three groups, namely, Group I - Oral SCC (OSCC) (n = 42), Group II – PMDs (n = 32) and Group III – Oral healthy mucosa (n = 32) subjected to immunohistochemical analysis using alpha Smooth Muscle Actin.RESULTS: Among the 42 cases of OSCC, the staining index was negative in 23 cases (54.7%), low in 9 cases(21.4%) and moderate in 10 cases (23.8%). The stroma of cases of verrucous carcinoma, cases of Hyperkeratosis with epithelial dysplasia, 77.5% of the cases of oral Submucous Fibrosis (OSMF) and healthy oral mucosa were devoid of myofibroblasts resulting in a grade of “0” in all cases.Two of the cases of OSMF (12.5%) showed low staining index for myofibroblast. There was a significant difference in the myofibroblasts expression between the Groups (Kruskal-Wallis test P<0.001). CONCLUSION: The findings of the current study justify “myofibroblast” as one among the key stromal element in tumor progression. Future studies involving a larger sample size along with follow up of patients with PMDs are essential to identify the exact stage in which they emerge in the stroma of these lesions.

Determining toothache severity in pediatric patients: A study.

To correlate sodium-potassium levels in saliva of pediatric patients having different intensities of toothache assessed by Visual Analogue Scale (VAS) in age group 3-14 yrs. A prospective study of 50 children having different intensities of pain was carried out in the Dept. of Pedodontics, Sareetha Dental College and Hospital. 50 children (aged 3-14 yrs) having different intensities of toothache including normal children (control) were included in the study. Saliva samples were collected and Na+, K+ levels in saliva were measured by using Na+, k+ colorimeter kit. Photographs were taken using Digital camera and VAS was prepared accordingly. Sodium levels decreased with increasing pain intensity and potassium levels increased, facial expressions correlated with Na+, K+ levels. Correlation between Na+, K+ levels and pain intensity exists. Also, VAS is a valid measure for pain.

Meralgia paraesthetica following lumbar spine surgery: a study in 110 consecutive surgically treated cases.

BACKGROUND: Lateral cutaneous femoral nerve (LCFN) injury or Meralgia paraesthetica (MP) results in restriction of activity. Compression of the nerve by disc hernia, retroperitoneal tumors, and external pressure around the anterior superior iliac spine is common. However, it is not commonly observed after lumbar spinal surgery in prone position. STUDY DESIGN: In this prospective study of 110 patients who underwent elective lumbar spinal surgery, managed from January 2002 to June 2002, the incidence, possible risk factors, etiopathogenesis and management of MP were analyzed. RESULTS: There were 66 males and 44 females. The age of the patients ranged from 15 to 81 years (mean 46.9 yrs.). Thirteen patients (12%) suffered from MP. It is more common in thinner individuals due to pressure injury to the nerve at its exit point. Ninety-two per cent of the patients were asymptomatic at follow-up after 6 months. In 7 out of 13 patients, patchy sensory loss on clinical examination was seen at 6 months. CONCLUSION: MP after posterior lumbar spinal surgery is uncommon. Smaller bolsters may avoid some of the vulnerable pressure points, as the surface area available is relatively smaller. The posts of the Hall-Relton frame over the anterior superior iliac crest should be adequately padded. The condition is usually self-limiting. Surgical division or decompression of the LCFN is reserved for persistent or severe MP.

Combined anterior and posterior decompression and short segment fixation for unstable burst fractures in the dorso lumbar region.

The dorso lumbar segment of spine (D10 to L2) is an unstable zone between fixed dorsal and mobile lumbar spine. A combined anterior and posterior approach with short segment stabilization was found most appropriate. Thirty cases were treated over a period of 4 years and 6 months. There were 26 male and 4 female patients with mean age of 32.6 years. L1 vertebra was fractured in 17 cases, D1 in 8 cases, D11 in 4 cases and D10 in one case. 14 cases had total neurological deficit, 9 cases had partial and 7 had no neurological deficit. We have used three column classification of Denis to assess the cases. Seven patients returned to regular physical work, 5 had restricted physical work, 5 remained in full time light job and 9 patients were unable to return to original job but did some work. Most had flaccid paraplegia but 4 patients were completely disabled due to spastic paraplegia. Neurological recovery occurred in all the patients with partial paralysis, and appeared to be dependent on initial kyphosis. The overall recovery rate varied from 50% to 90%. There is no correlation between canal compromise and severity of injury. Neurological injury occured at the time of trauma, rather than as a result of pressure of fragment in the canal. No strong conclusion could be drawn to say that the results of surgery were superior to non-operative treatment.

A radiological evaluation of allografts (ethylene oxide sterilized cadaver bone) and autografts in anterior cervical fusion.

Serial roentgenograms of 40 patients who had 70 cervical intervertebral spaces grafted with ethylene oxide sterilized cadaver bone and 28 patients who received 44 iliac crest auto grafts for anterior cervical spine fusion, were studied. The radiological evaluation was made on the basis of settlement of intervertebral spaces, fusion rate, delayed union, non-union, graft collapse and extrusion of the graft. Indigenous methodologies were designed for the assessment of settlement of grafted intervertebral spaces in percentage. Disc space settlement was more common in autografts (93% cases) than in allografts (80% cases). The average percentage of settlement of intervertebral disc space (S%) was 22 in autografts and 28 in allografts during the first four months. By the end of eight months, allograft disc spaces settle more. No significant difference was noted in fusion rate at the end of one year viz. allografts (90% cases) and autografts (93% cases). Autograft and allograft (ethylene oxide sterilized cadaver bone) are equally useful in anterior cervical spine fusions.